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Korean J Adult Nurs : Korean Journal of Adult Nursing

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Original Research

The Effect of Caregiver Reaction on Psychological Well-being among Family Caregivers of Cancer Patients

Kyoung Hee Kim, MSN, APN1, Yong Soon Shin, Ph.D., APN2
Korean Journal of Adult Nursing 2017;29(6):647-656.
Published online: December 18, 2017

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Corresponding author: Shin, Yong Soon School of Nursing, Hanyang University, 222 Wangsimni-ro, Seongdong-gu, Seoul 04763, Korea. Tel: +82-2-2220-0798, Fax: +82-2-2220-1163, E-mail: ysshin2k@hanyang.ac.kr
• Received: September 7, 2017   • Accepted: December 17, 2017

© 2017 Korean Society of Adult Nursing

This is an open access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/ by-nc/3.0), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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  • Purpose
    This study was designed to explore positive and negative aspects of the caregiver reaction and identify factors influencing psychological well-being among family caregivers of home-based cancer patients.
  • Methods
    The participants were 139 family caregivers from two cities. These caregivers took care of he family member in the home. Data were collected utilizing the Caregiver Reaction Assessment Scale and the Psychological Well-being Scale.
  • Results
    Self-esteem was the highest reaction reported among the family caregivers. There were sig-nificant correlations between caregiver reaction and their psychological well-being. In multiple regression analy-sis, self-esteem and family support were predictors of psychological well-being among family caregivers (F=13.71, p<.001, Adj. R2=.393).
  • Conclusion
    The results demonstrated that self-esteem and family support impacts the psychological well-being among cancer family caregivers. Thus, nursing intervention are needed to enhance self-esteem to improve psychological well-being among family caregivers.
  • Key Words: Mental health; Family caregivers; Caring; Neoplasms
Table 1.
Differences in Psychological Well-being based on General Characteristics (N=139)
Characteristics Categories n (%) Psychological well-being
M± SD t or F p Scheffé
Age (year) ＜30 a 34 (24.5) 4.22±0.51 7.31 ＜.001 a＞ b, c, d
30~39 b 27 (19.4) 3.87±0.53      
40~49 c 43 (30.9) 3.79±0.47      
≥50 d 35 (25.2) 3.70±0.47      
Gender Male 42 (30.2) 4.05±0.49 2.51 .013  
Female 97 (69.8) 3.81±0.53      
Relationship Spouse a 16 (11.5) 3.66±0.59 2.36 .044 f＞ a
Parent b 8 (5.8) 3.95±0.40      
Children c 65 (46.8) 3.88±0.51      
Sibling d 16 (11.5) 3.74±0.57      
Daughter-in-law e 8 (5.8) 3.76±0.56      
Grandchilden f 26 (18.7) 4.15±0.47      
Length of being a caregiver (year) ＜1 a 38 (27.3) 3.97±0.43 1.20 .303  
1~3 b 52 (37.4) 3.91±0.58      
≥3 c 49 (35.3) 3.80±0.54      
Monthly household income (10,000 won) ＜200 a 28 (20.1) 3.64±0.54 4.58 .012 c＞ a
200~400 b 51 (36.7) 3.89±0.48      
≥400 c 60 (43.2) 4.00±0.53      
Occupation Yes 88 (63.3) 4.00±0.48 3.32 .002  
No 51 (36.7) 3.70±0.55      
Hours of caregiving per day ＜3 a 68 (48.9) 3.97±0.52 1.75 .178  
3~6 b 40 (28.8) 3.82±0.51      
≥6 c 31 (22.3) 3.78±0.54      
Living arrangement With 47 (33.8) 3.78±0.49 -1.75 .082  
Not living together 92 (66.2) 3.94±0.54      
ECOG-PS (patient) 0 a 33 (23.7) 4.05±0.51 2.69 .034 a, e＞ c
1 b 52 (37.4) 3.82±0.60      
2 c 28 (20.1) 3.68±0.36      
3 d 15 (10.8) 4.01±0.41      
4 e 11 (7.9) 4.05±0.56      
Treatment progress (patient) Waiting for treatment a 5 (3.6) 3.97±0.65 0.18 .912  
Under treatment b 31 (22.3) 3.84±0.50      
After treatment c 71 (51.1) 3.89±0.57      
Terminal stage d 32 (23.0) 3.92±0.46      

ECOG-PS=eastern cooperative oncology group scale of performance status.

Table 2.
Scores of Caregiver Reaction and Psychological Well-being (N=139)
Variables Subscales Range Min Max M± SD
Caregiver reaction Disrupted schedule 1~5 1.00 4.80 2.97±0.75
Financial problems 1~5 1.00 5.00 2.84±0.79
Health problems 1~5 1.00 5.00 2.71±0.80
Lack of family support 1~5 1.00 4.00 2.27±0.74
Caregiver self-esteem 1~5 1.67 4.83 3.16±0.62

Psychological well-being 1~6 2.39 5.11 3.89±0.53

Table 3.
Differences in Caregiver Reaction based on General Characteristics (N=139)
Characteristics Categories Disrupted schedule Lack of family support Health problem Financial problem Self-esteem
M± SD t or F (p) Scheffé M± SD t or F (p) Scheffe M± SD t or F (p) Scheffe M± SD t or F (p) Scheffe M± SD t or F (p) Scheffe
Age (year) ＜30 a 2.66±0.74 5.60 1.94±0.73 33.83 2.36±0.81 4.64 2.79±0.83 1.31 3.28±0.65 1.15
30~39 b 2.87±0.63 (.001) 2.24±0.70 0(.011) 2.63±0.78 (.004) 2.62±0.74 (.274) 3.09±0.51 (.332)
40~49 c 2.95±0.73 d＞ a 2.42±0.72 2 d＞ a 2.78±0.80 d＞ a 2.99±0.68   3.05±0.55  
≥50 d 3.35±0.74   2.44±0.70 0 3.04±0.68   2.86±0.89   3.22±0.72  
Gender Male 2.78±0.67 -1.94 2.13±0.65 5-1.49 2.48±0.78 -2.25 3.00±0.79 1.62 3.23±0.54 0.94
Female 3.05±0.77 (.054) 2.33±0.77 7(.140) 2.81±0.79 (.026) 2.77±0.78 (.108) 3.13±0.65 (.350)
Relationship Spouse a 3.58±0.83 4.60 2.44±0.62 21.49 3.10±0.85 3.37 2.81±1.06 0.20 3.33±0.88 2.33
Parent b 3.13±0.74 (.001) 2.48±0.95 5(.197) 3.13±0.83 (.007) 2.92±0.68 (.962) 2.88±0.79 (.046)
Children c d 2.97±0.65 a＞ f 2.21±0.78 8 2.65±0.81 b＞ f 2.83±0.75   3.24±0.55 a＞ e
Sibling d 2.93±0.68   2.56±0.60 0 3.02±0.56   2.81±0.60   3.31±0.50  
Daughter-in-law e 3.13±0.60   2.45±0.69 9 2.75±0.61   3.08±0.66   2.71±0.71  
Grandchildren f 2.52±0.79   2.05±0.67 7 2.31±0.74   2.78±0.90   2.99±0.48  
Length of being a caregiver (year) ＜1 a 2.86±0.69 3.12 2.10±0.59 92.62 2.50±0.80 1.94 2.70±0.71 1.17 3.21±0.52 2.32
1~3 b 3.17±0.67 (.047) 2.24±0.78 8(.077) 2.82±0.76 (.148) 2.82±0.81 (.315) 3.26±0.61 (.102)
≥3 c 2.84±0.83 b＞ c 2.45±0.76 6 2.76±0.82   2.96±0.82   3.01±0.67  
Monthly household income (10,000 won) ＜200 a 3.34±0.77 4.64 2.56±0.83 32.66 2.99±0.85 2.22 3.00±0.95 0.95 3.35±0.77 6.30
200~400 b c 2.86±0.71 (.011) 2.20±0.71 1(.074) 2.61±0.75 (.113) 2.75±0.71 (.390) 3.29±0.49 (.002)
≥400 c 2.88±0.73 a＞ b, c 2.20±0.69 9 2.67±0.80   2.84±0.77   2.96±0.58 a, b＞ c
                     
Occupation Yes 2.93±0.64 -0.66 2.18±0.69 9-2.04 2.70±0.77 -0.22 2.93±0.81 1.81 3.19±0.60 0.70
No 3.03±0.91 (.511) 2.44±0.79 9(.043) 2.73±0.85 (.825) 2.68±0.72 (.073) 3.11±0.65 (.484)
Hours of caregiving per day ＜3 a 2.67±0.70 21.44 2.06±0.70 08.16 2.44±0.76 12.07 2.75±0.83 3.52 3.08±0.61 1.02
3~6 b c 2.98±0.71 (＜.001) 2.35±0.70 0(＜.001) 2.79±0.78 (＜.001) 2.74±0.78 (.032) 3.23±0.69 (.365)
≥6 c 3.61±0.48 c＞ a, b 2.66±0.70 0 c＞ a 3.22±0.64 c＞ a, b 3.16±0.62 c＞ b 3.24±0.52  
Living arrangement With 3.30±0.71 3.90 2.45±0.78 82.00 2.94±0.82 2.40 2.89±0.74 0.61 3.22±0.70 0.87
Not living together 2.80±0.72 (＜.001) 2.19±0.70 0(.047) 2.60±0.77 (.018) 2.81±0.81 (.546) 3.13±0.57 (.384)
ECOG-PS (patient) 0 a 2.71±0.71 1.97 2.00±0.80 01.88 2.34±0.81 2.42 2.58±0.71 1.77 3.23±0.66 1.64
1 b 3.05±0.59 (.103) 2.33±0.67 7(.117) 2.83±0.58 (.052) 2.84±0.82 (.140) 3.12±0.65 (.169)
2 c 2.89±0.85   2.41±0.66 6 2.81±0.94   2.92±0.80   2.98±0.63  
3 d 3.24±1.10   2.50±0.91 1 2.82±1.05   2.98±0.88   3.46±0.42  
4 e 3.16±0.58   2.18±0.62 2 2.88±0.65   3.21±0.54   3.17±0.29  
Treatment phase (patient) Waiting fortreatment a b 2.64±0.54 2.05 2.28±0.70 00.21 2.47±0.90 2.19 2.33±0.62 0.95 2.83±0.53 2.74
Under treatment b 2.96±0.59 (.110) 2.30±0.73 3(.893) 2.63±0.75 (.092) 2.87±0.85 (.420) 3.35±0.62 (.046)
After treatment c d 2.87±0.78   2.23±0.75 5 2.62±0.81   2.81±0.78   3.05±0.61 d＞ a
Terminal state d 3.23±0.80   2.35±0.73 3 3.02±0.77   2.95±0.76   3.27±0.58  

ECOG-PS=eastern cooperative oncology group scale of performance status.

Table 4.
Correlations between Caregiver Reaction and Psychological Well-being (N=139)
Variables Caregiver reaction
Disrupted schedule Lack of family support Health problem Financial problem Self-esteem
r (p) r (p) r (p) r (p) r (p)
Psychological well-being -.216 (.011) -.472 (＜.001) -.290 (.001) -.178 (.036) .238 (.005)
Table 5.
Influencing Factors on Psychological Well-being among Family Caregivers of Home based Cancer Patients (N=139)
Variables B SE β t p
(Constant) 4.18 .30   13.75 ＜.001
Lack of family support -0.19 .05 -.27 -3.68 ＜.001
Caregiver self-esteem 0.22 .06 .25 3.40 .001
Occupation: Yes (reference=No) 0.25 .07 .23 3.44 .001
Age -0.01 .00 -.23 -3.20 .002
Monthly household income: ＞400(reference＜200) (10,000 won) 0.23 .08 .22 3.05 .003
Relationship: Grandchildren (reference=Spouses) 0.25 .10 .19 2.61 .010
  F=13.71, p＜.001, Adjusted R2=.393, R2=.424
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    The Effect of Caregiver Reaction on Psychological Well-being among Family Caregivers of Cancer Patients
    Korean J Adult Nurs. 2017;29(6):647-656.   Published online December 31, 2017
    DOI: https://doi.org/10.7475/kjan.2017.29.6.647
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    The Effect of Caregiver Reaction on Psychological Well-being among Family Caregivers of Cancer Patients
    Korean J Adult Nurs. 2017;29(6):647-656.   Published online December 31, 2017
    DOI: https://doi.org/10.7475/kjan.2017.29.6.647
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    The Effect of Caregiver Reaction on Psychological Well-being among Family Caregivers of Cancer Patients
    The Effect of Caregiver Reaction on Psychological Well-being among Family Caregivers of Cancer Patients

    Differences in Psychological Well-being based on General Characteristics (N=139)

    Characteristics Categories n (%) Psychological well-being
    M± SD t or F p Scheffé
    Age (year) ＜30 a 34 (24.5) 4.22±0.51 7.31 ＜.001 a＞ b, c, d
    30~39 b 27 (19.4) 3.87±0.53      
    40~49 c 43 (30.9) 3.79±0.47      
    ≥50 d 35 (25.2) 3.70±0.47      
    Gender Male 42 (30.2) 4.05±0.49 2.51 .013  
    Female 97 (69.8) 3.81±0.53      
    Relationship Spouse a 16 (11.5) 3.66±0.59 2.36 .044 f＞ a
    Parent b 8 (5.8) 3.95±0.40      
    Children c 65 (46.8) 3.88±0.51      
    Sibling d 16 (11.5) 3.74±0.57      
    Daughter-in-law e 8 (5.8) 3.76±0.56      
    Grandchilden f 26 (18.7) 4.15±0.47      
    Length of being a caregiver (year) ＜1 a 38 (27.3) 3.97±0.43 1.20 .303  
    1~3 b 52 (37.4) 3.91±0.58      
    ≥3 c 49 (35.3) 3.80±0.54      
    Monthly household income (10,000 won) ＜200 a 28 (20.1) 3.64±0.54 4.58 .012 c＞ a
    200~400 b 51 (36.7) 3.89±0.48      
    ≥400 c 60 (43.2) 4.00±0.53      
    Occupation Yes 88 (63.3) 4.00±0.48 3.32 .002  
    No 51 (36.7) 3.70±0.55      
    Hours of caregiving per day ＜3 a 68 (48.9) 3.97±0.52 1.75 .178  
    3~6 b 40 (28.8) 3.82±0.51      
    ≥6 c 31 (22.3) 3.78±0.54      
    Living arrangement With 47 (33.8) 3.78±0.49 -1.75 .082  
    Not living together 92 (66.2) 3.94±0.54      
    ECOG-PS (patient) 0 a 33 (23.7) 4.05±0.51 2.69 .034 a, e＞ c
    1 b 52 (37.4) 3.82±0.60      
    2 c 28 (20.1) 3.68±0.36      
    3 d 15 (10.8) 4.01±0.41      
    4 e 11 (7.9) 4.05±0.56      
    Treatment progress (patient) Waiting for treatment a 5 (3.6) 3.97±0.65 0.18 .912  
    Under treatment b 31 (22.3) 3.84±0.50      
    After treatment c 71 (51.1) 3.89±0.57      
    Terminal stage d 32 (23.0) 3.92±0.46      

    ECOG-PS=eastern cooperative oncology group scale of performance status.

    Scores of Caregiver Reaction and Psychological Well-being (N=139)

    Variables Subscales Range Min Max M± SD
    Caregiver reaction Disrupted schedule 1~5 1.00 4.80 2.97±0.75
    Financial problems 1~5 1.00 5.00 2.84±0.79
    Health problems 1~5 1.00 5.00 2.71±0.80
    Lack of family support 1~5 1.00 4.00 2.27±0.74
    Caregiver self-esteem 1~5 1.67 4.83 3.16±0.62

    Psychological well-being 1~6 2.39 5.11 3.89±0.53

    Differences in Caregiver Reaction based on General Characteristics (N=139)

    Characteristics Categories Disrupted schedule Lack of family support Health problem Financial problem Self-esteem
    M± SD t or F (p) Scheffé M± SD t or F (p) Scheffe M± SD t or F (p) Scheffe M± SD t or F (p) Scheffe M± SD t or F (p) Scheffe
    Age (year) ＜30 a 2.66±0.74 5.60 1.94±0.73 33.83 2.36±0.81 4.64 2.79±0.83 1.31 3.28±0.65 1.15
    30~39 b 2.87±0.63 (.001) 2.24±0.70 0(.011) 2.63±0.78 (.004) 2.62±0.74 (.274) 3.09±0.51 (.332)
    40~49 c 2.95±0.73 d＞ a 2.42±0.72 2 d＞ a 2.78±0.80 d＞ a 2.99±0.68   3.05±0.55  
    ≥50 d 3.35±0.74   2.44±0.70 0 3.04±0.68   2.86±0.89   3.22±0.72  
    Gender Male 2.78±0.67 -1.94 2.13±0.65 5-1.49 2.48±0.78 -2.25 3.00±0.79 1.62 3.23±0.54 0.94
    Female 3.05±0.77 (.054) 2.33±0.77 7(.140) 2.81±0.79 (.026) 2.77±0.78 (.108) 3.13±0.65 (.350)
    Relationship Spouse a 3.58±0.83 4.60 2.44±0.62 21.49 3.10±0.85 3.37 2.81±1.06 0.20 3.33±0.88 2.33
    Parent b 3.13±0.74 (.001) 2.48±0.95 5(.197) 3.13±0.83 (.007) 2.92±0.68 (.962) 2.88±0.79 (.046)
    Children c d 2.97±0.65 a＞ f 2.21±0.78 8 2.65±0.81 b＞ f 2.83±0.75   3.24±0.55 a＞ e
    Sibling d 2.93±0.68   2.56±0.60 0 3.02±0.56   2.81±0.60   3.31±0.50  
    Daughter-in-law e 3.13±0.60   2.45±0.69 9 2.75±0.61   3.08±0.66   2.71±0.71  
    Grandchildren f 2.52±0.79   2.05±0.67 7 2.31±0.74   2.78±0.90   2.99±0.48  
    Length of being a caregiver (year) ＜1 a 2.86±0.69 3.12 2.10±0.59 92.62 2.50±0.80 1.94 2.70±0.71 1.17 3.21±0.52 2.32
    1~3 b 3.17±0.67 (.047) 2.24±0.78 8(.077) 2.82±0.76 (.148) 2.82±0.81 (.315) 3.26±0.61 (.102)
    ≥3 c 2.84±0.83 b＞ c 2.45±0.76 6 2.76±0.82   2.96±0.82   3.01±0.67  
    Monthly household income (10,000 won) ＜200 a 3.34±0.77 4.64 2.56±0.83 32.66 2.99±0.85 2.22 3.00±0.95 0.95 3.35±0.77 6.30
    200~400 b c 2.86±0.71 (.011) 2.20±0.71 1(.074) 2.61±0.75 (.113) 2.75±0.71 (.390) 3.29±0.49 (.002)
    ≥400 c 2.88±0.73 a＞ b, c 2.20±0.69 9 2.67±0.80   2.84±0.77   2.96±0.58 a, b＞ c
                         
    Occupation Yes 2.93±0.64 -0.66 2.18±0.69 9-2.04 2.70±0.77 -0.22 2.93±0.81 1.81 3.19±0.60 0.70
    No 3.03±0.91 (.511) 2.44±0.79 9(.043) 2.73±0.85 (.825) 2.68±0.72 (.073) 3.11±0.65 (.484)
    Hours of caregiving per day ＜3 a 2.67±0.70 21.44 2.06±0.70 08.16 2.44±0.76 12.07 2.75±0.83 3.52 3.08±0.61 1.02
    3~6 b c 2.98±0.71 (＜.001) 2.35±0.70 0(＜.001) 2.79±0.78 (＜.001) 2.74±0.78 (.032) 3.23±0.69 (.365)
    ≥6 c 3.61±0.48 c＞ a, b 2.66±0.70 0 c＞ a 3.22±0.64 c＞ a, b 3.16±0.62 c＞ b 3.24±0.52  
    Living arrangement With 3.30±0.71 3.90 2.45±0.78 82.00 2.94±0.82 2.40 2.89±0.74 0.61 3.22±0.70 0.87
    Not living together 2.80±0.72 (＜.001) 2.19±0.70 0(.047) 2.60±0.77 (.018) 2.81±0.81 (.546) 3.13±0.57 (.384)
    ECOG-PS (patient) 0 a 2.71±0.71 1.97 2.00±0.80 01.88 2.34±0.81 2.42 2.58±0.71 1.77 3.23±0.66 1.64
    1 b 3.05±0.59 (.103) 2.33±0.67 7(.117) 2.83±0.58 (.052) 2.84±0.82 (.140) 3.12±0.65 (.169)
    2 c 2.89±0.85   2.41±0.66 6 2.81±0.94   2.92±0.80   2.98±0.63  
    3 d 3.24±1.10   2.50±0.91 1 2.82±1.05   2.98±0.88   3.46±0.42  
    4 e 3.16±0.58   2.18±0.62 2 2.88±0.65   3.21±0.54   3.17±0.29  
    Treatment phase (patient) Waiting fortreatment a b 2.64±0.54 2.05 2.28±0.70 00.21 2.47±0.90 2.19 2.33±0.62 0.95 2.83±0.53 2.74
    Under treatment b 2.96±0.59 (.110) 2.30±0.73 3(.893) 2.63±0.75 (.092) 2.87±0.85 (.420) 3.35±0.62 (.046)
    After treatment c d 2.87±0.78   2.23±0.75 5 2.62±0.81   2.81±0.78   3.05±0.61 d＞ a
    Terminal state d 3.23±0.80   2.35±0.73 3 3.02±0.77   2.95±0.76   3.27±0.58  

    ECOG-PS=eastern cooperative oncology group scale of performance status.

    Correlations between Caregiver Reaction and Psychological Well-being (N=139)

    Variables Caregiver reaction
    Disrupted schedule Lack of family support Health problem Financial problem Self-esteem
    r (p) r (p) r (p) r (p) r (p)
    Psychological well-being -.216 (.011) -.472 (＜.001) -.290 (.001) -.178 (.036) .238 (.005)

    Influencing Factors on Psychological Well-being among Family Caregivers of Home based Cancer Patients (N=139)

    Variables B SE β t p
    (Constant) 4.18 .30   13.75 ＜.001
    Lack of family support -0.19 .05 -.27 -3.68 ＜.001
    Caregiver self-esteem 0.22 .06 .25 3.40 .001
    Occupation: Yes (reference=No) 0.25 .07 .23 3.44 .001
    Age -0.01 .00 -.23 -3.20 .002
    Monthly household income: ＞400(reference＜200) (10,000 won) 0.23 .08 .22 3.05 .003
    Relationship: Grandchildren (reference=Spouses) 0.25 .10 .19 2.61 .010
      F=13.71, p＜.001, Adjusted R2=.393, R2=.424
    Table 1. Differences in Psychological Well-being based on General Characteristics (N=139)

    ECOG-PS=eastern cooperative oncology group scale of performance status.

    Table 2. Scores of Caregiver Reaction and Psychological Well-being (N=139)

    Psychological well-being 1~6 2.39 5.11 3.89±0.53

    Table 3. Differences in Caregiver Reaction based on General Characteristics (N=139)

    ECOG-PS=eastern cooperative oncology group scale of performance status.

    Table 4. Correlations between Caregiver Reaction and Psychological Well-being (N=139)

    Table 5. Influencing Factors on Psychological Well-being among Family Caregivers of Home based Cancer Patients (N=139)

    Table 1.

    Table 2.

    Table 3.

    Table 4.

    Table 5.

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